MEDICARE: PREMISE HEALTH OF ILLINOIS MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1588940019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMISE HEALTH OF ILLINOIS MEDICAL PC

Provider Business Mailing Address
First Line	:	5500 MARYLAND WAY STE 120
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 SANDERS RD
Second Line	:	SUITE C1
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-6110
Country	:	US
Telephone Number	:	703-760-0700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDWARD WILLIAM SCHWARTZ
Credential	:
Telephone Number	:	844-407-7557

Provider Enumeration Date	:	10/28/2011
Last Update Date	:	02/12/2026

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